Objectives: This presentation describes the main published complications and proposes safe techniques to avoid them.

Introduction: Gluteal augmentation by autologous fat injection is an intervention that has shown remarkable development in recent years. Severe and even fatal complications have been described and published. Mortality is about 1 case per 3500; making it one of the most risky cosmetic surgery interventions.

Materials / method: An analysis of complications and a review of the literature are proposed. The main techniques of liposuction, fat purification and gluteal lipofilling are presented and their specific risks are explained. . After a description of the gluteal anatomy, the fatty compartments are analyzed. Clinical cases illustrate the proposed techniques. Most commonly reported complications in patients receiving an autologous fat injection are seroma, under-correction, infection, and sciatica. Most serious are: fatty embolism by injection into gluteal vein and injury of external iliac artery.

Results: The risks specific to each plan (subcutaneous and intramuscular), and the technique used (syringes , blunt cannula , purification of the fat by decantation, filtration, washing, centrifugation, calibration) are presented. The safest techniques are: retrograde reinjection without excessive pressure which avoids bolus, subcutaneous and pre-muscular injection. Injection into the infra-gluteal fold should be careful (risk of intramuscular injection and fat embolism). A 4 mm diameter blunt cannula is recommended. These techniques are illustrated by photos and videos.

Conclusion: Buttock enhancement by lipofilling is a procedure that must be secured by safe and effective techniques, as severe complications such as fat embolism and death have been published and are still too common. Obtaining optimal and natural results need a safe technique.

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Objectives: Evaluate the effects of gluteal lipofilling and select patients to be filled with macromolecular hyaluronic acid, always respecting maximum safety

Introduction: The lipostructure represents a significant stage in the evolution of the surgical approach to body contouring. More and more often, we face surgically various regions of the body in a more complete way, following the modern aesthetic concepts of three-dimensionality. In particular, in the specific case of the gluteal region, in our surgical experience we do not just remove fat through liposuction in various locations of accumulation, but associate lipofilling with the goal of increasing volume, both to improve the tone of the tissues.

Materials / method: The goal of treatment in buttock remodeling is to improve the profile especially of the upper pole, creating a more pleasant curve. To improve buttock profile we perform liposuction in aroun it and, at the same time, perform lipofilling to increase tissue volume and consistency and to improve the skin surface. In patients with low availability of adipose tissue or in those who did not want to undergo more invasive surgery, we performed hyaluronic macromolecular acid injection. The treatment consists in the injection subcutaneously and over the muscle.

Results: The results obtained with the association of liposuction at the periphery of the gluteal region and the lipofilling of the buttock are certainly good and stable over time. The cases treated with hyaluronic acid all present the problem of resorption and the need to repeat the treatment.

Conclusion: Liposuction and lipofilling are the treatment of choice for gluteus remodeling but in selected cases the macromolecular hyaluronic acid can be considered an alternative for patients who do not want undergo more invasive surgery.
Any surgical procedure, especially of Aesthetics, must be carried out with the utmost safety. Knowledge of anatomy, not infiltrating into the gluteal muscle, implant site, cannula size and injection speed are the key points for performing lipofilling or HA injection of the buttocks in extreme safety.

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